A postsurgical client has been receiving morphine by patient-controlled analgesia for 2 days. What action by the nurse best addresses potential adverse effects?
administering a stool softener as prescribed
auscultating the client's lung for adventitious sounds
encouraging active range of motion exercises
applying calf compressors as prescribed
The Correct Answer is A
A. Administering a stool softener is essential as opioids like morphine commonly cause constipation, and this proactive measure helps mitigate that adverse effect.
B. While auscultating the lungs is important to monitor respiratory function, it does not specifically address a common adverse effect of morphine.
C. Encouraging active range of motion exercises can help prevent complications from immobility but does not directly address the most common adverse effect of morphine.
D. Applying calf compressors can help prevent deep vein thrombosis, but it is not the most effective action for addressing the specific adverse effects of morphine use.
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Correct Answer is C
Explanation
A. Chest pain and pale skin are not typical adverse effects associated with diltiazem use.
B. Shortness of breath and wheezing may occur due to other conditions or medications but are not common adverse effects of diltiazem.
C. Calcium channel blockers like diltiazem can cause peripheral edema due to vasodilation and bradycardia as a result of their action on the heart rate. Monitoring for these effects is essential in patients taking diltiazem.
D. Tachycardia is not an expected adverse effect of diltiazem; in fact, it is used to manage conditions where tachycardia may be present. Anxiety is also not a direct adverse effect of this medication.
Correct Answer is B
Explanation
A. Rebound hypertension can occur if antihypertensive medications are abruptly stopped, but it is not a direct reason for switching from an ACE inhibitor to an angiotensin II receptor blocker.
B. A persistent cough is a well-known side effect of ACE inhibitors due to the accumulation of bradykinin. If the client experienced this side effect, it would likely prompt the healthcare provider to switch to an angiotensin II receptor blocker, which does not typically cause this issue.
C. A transient ischemic attack (TIA) would require urgent intervention but is not a reason for changing from an ACE inhibitor to an angiotensin II receptor blocker.
D. Non-adherence to ACE inhibitor treatment may lead to ineffective blood pressure control but would not directly justify a switch to a different class of medication.